Abstract Introduction: The progression of diabetes mellitus to a global epidemic resulted in an increased prevalence of tibioperoneal disease in chronic limb threatening ischemia (CLTI). Distal disease still poses an enormous challenge to vascular surgeons. Crural angioplasty was formerly restricted to patients with short stenotic lesions or to high-risk patients for bypass surgery. Nevertheless, endovascular treatment has been used preferentially over bypass surgery in most centres. The aim of this study is to analyse the results of open ultra-distal revascularization in a single-centre with a limb preservation program for CLTI. Methods: The present study consists in a single-centre retrospective analysis of all patients with CLTI submitted to below the ankle bypass. The end points were limb-based patency (LBP), primary patency (PP) and secondary patency (SP) rates, freedom from CLTI, freedom from new CLTI, freedom from major index limb amputation, amputation free-survival, and overall survival. Patients were categorized in subgroups based on age (above or below 75 years), dialysis status, wound and infection grade (0 and 1 vs 2 and 3 in WIfI classification). Statistical analysis was carried out using Stata 12.1 (StataCorp®, Lakeway Drive, College Station, Texas, USA). Time-to-event end points were presented with Kaplan-Meier estimates, censored at major amputation, death, or last follow-up, and compared with the log rank test. Results: A total of 134 limbs in 122 patients with CLTI (83% male, median age of 68 years) were submitted to below the ankle bypasses. The median follow-up was 33.7 months. LBP, PP and SP were, respectively, 78%, 78% and 92% at 1 year, 73%, 73% and 88% at 2 years, and 62%, 62% and 79% at 4 years. At 1 year, 83% of the limbs were free from CLTI. Of these patients, 89% and 74% remained free from new CLTI at 2 and 4 years, respectively. Eighty-two percent of the patients were free from major index limb amputation at 4 years. Thirty-day mortality was 1.6% (2 patients) and 1-year and 2-year survival was 90% and 81%, respectively. Age, dialysis status and wound/infection grade (WIfI classification) did not influence patency rates. Conclusion: Below the ankle bypass is safe and has excellent clinical outcomes. The present study emphasizes the value of open surgery in a challenging territory, with high rates of patency, limb salvage, freedom from CLTI and from new CLTI. These results were not affected by patient status or clinical severity factors.

Abstract Introduction: The progression of diabetes mellitus to a global epidemic resulted in an increased prevalence of tibioperoneal disease in chronic limb threatening ischemia (CLTI). Distal disease still poses an enormous challenge to vascular surgeons. Crural angioplasty was formerly restricted to patients with short stenotic lesions or to high-risk patients for bypass surgery. Nevertheless, endovascular treatment has been used preferentially over bypass surgery in most centres. The aim of this study is to analyse the results of open ultra-distal revascularization in a single-centre with a limb preservation program for CLTI. Methods: The present study consists in a single-centre retrospective analysis of all patients with CLTI submitted to below the ankle bypass. The end points were limb-based patency (LBP), primary patency (PP) and secondary patency (SP) rates, freedom from CLTI, freedom from new CLTI, freedom from major index limb amputation, amputation free-survival, and overall survival. Patients were categorized in subgroups based on age (above or below 75 years), dialysis status, wound and infection grade (0 and 1 vs 2 and 3 in WIfI classification). Statistical analysis was carried out using Stata 12.1 (StataCorp®, Lakeway Drive, College Station, Texas, USA). Time-to-event end points were presented with Kaplan-Meier estimates, censored at major amputation, death, or last follow-up, and compared with the log rank test. Results: A total of 134 limbs in 122 patients with CLTI (83% male, median age of 68 years) were submitted to below the ankle bypasses. The median follow-up was 33.7 months. LBP, PP and SP were, respectively, 78%, 78% and 92% at 1 year, 73%, 73% and 88% at 2 years, and 62%, 62% and 79% at 4 years. At 1 year, 83% of the limbs were free from CLTI. Of these patients, 89% and 74% remained free from new CLTI at 2 and 4 years, respectively. Eighty-two percent of the patients were free from major index limb amputation at 4 years. Thirty-day mortality was 1.6% (2 patients) and 1-year and 2-year survival was 90% and 81%, respectively. Age, dialysis status and wound/infection grade (WIfI classification) did not influence patency rates. Conclusion: Below the ankle bypass is safe and has excellent clinical outcomes. The present study emphasizes the value of open surgery in a challenging territory, with high rates of patency, limb salvage, freedom from CLTI and from new CLTI. These results were not affected by patient status or clinical severity factors.

Abstract Preterm birth (PTB) is the main condition related to perinatal morbimortality worldwide. The aim of this study was to identify gene-environment interactions associated with spontaneous PTB or its predictors. We carried out a retrospective case-control study including parental sociodemographic and obstetric data as well as newborn genetic variants of 69 preterm and 61 at term newborns born at a maternity hospital from Tucumán, Argentina, between 2005 and 2010. A data-driven Bayesian network including the main PTB predictors was created where we identified gene-environment interactions. We used logistic regressions to calculate the odds ratios and confidence intervals of the interactions. From the main PTB predictors (nine exposures and six genetic variants) we identified an interaction between low neighbourhood socioeconomic status and rs2074351 (PON1, genotype GG) variant that was associated with an increased risk of toxoplasmosis (odds ratio 12.51, confidence interval 95%: 1.71 - 91.36). The results of this exploratory study suggest that structural social disparities could influence the PTB risk by increasing the frequency of exposures that potentiate the risk associated with individual characteristics such as genetic traits. Future studies with larger sample sizes are necessary to confirm these findings.

Resumo: Entre as espécies produtoras de grãos, a soja é uma das commodities mais importantes, com demanda crescente por produção nos próximos anos. A avaliação da qualidade da semente de soja é fundamental para garantir o máximo potencial de germinação e produtividade. Portanto, métodos eficazes são necessários para examinar diferentes propriedades associadas a alterações físico-químicas, fisiológicas e na sanidade das sementes que afetam a qualidade das sementes. Esta revisão enfoca os princípios fundamentais e a aplicação de técnicas de imagem radiográfica, ressonância magnética, imagem multiespectral, imagem de fluorescência de clorofila e termografia infravermelha para avaliar alterações relacionadas à perda de qualidade da semente de soja, como injúrias mecânicas, injúrias causadas por insetos, malformação embrionária e maturação incompleta. A análise computadorizada de imagens de plântulas também é apresentada para avaliação do vigor do lote de sementes. Os exemplos aqui apresentados mostram o potencial dessas técnicas de análise de imagens para identificar diferentes tipos de injúrias e aumentar a eficiência dos programas internos de controle de qualidade nas empresas produtoras de sementes de soja. Resumo grãos importantes anos produtividade Portanto físicoquímicas, físicoquímicas físico químicas, químicas físico-químicas radiográfica magnética multiespectral mecânicas insetos incompleta

Abstract: Among grain-producing species, soybean is one of the most important commodities, with increasing demand for production in coming years. Evaluation of soybean seed quality is fundamental for ensuring maximum germination and yield potential. Therefore, effective methods are necessary for examining different properties associated with physical-chemical, physiological, and seed-health changes that affect seed quality. This review focuses on the fundamental principles and on the application of techniques of radiographic imaging, magnetic resonance imaging, multispectral imagining, chlorophyll fluorescence imaging, and infrared thermography to evaluate changes related to loss of soybean seed quality, such as mechanical injury, injury caused by insects, embryonic malformation, and incomplete maturation. Computerized seedling image analysis is also presented for evaluation of seed lot vigor. The examples presented here show the potential of these image analysis techniques for identifying different types of injuries and increasing the efficiency of in-house quality control programs in soybean seed production companies. Abstract grainproducing grain producing species commodities years Therefore physicalchemical, physicalchemical physical chemical, chemical physical-chemical physiological seedhealth health imaging imagining insects malformation maturation vigor inhouse house companies

Abstract Introduction: The immune system can be affected by different factors, so sometimes the use of medicinal plants is an effective remedy to stimulate the defenses and prevent colds. With the arrival of the current COVID-19 pandemic, the demand for these herbal medicines has increased significantly, making it necessary for community pharmacists and other health professionals to be aware of them. Method: A bibliographic review has been carried out on different plants that act at the level of the immune system in different databases, specialized journals and books. Results: Echinacea purpurea (L.) Moench, Panax ginseng C.A. Meyer, Eleutherococcus senticosus Rupr. y Maxim. and Pelargonium sidoides DC. have demonstrated their immunostimulating activity, indicated for the prevention of mild respiratory diseases. On the other hand, different plants possessing vitamins and minerals that can exert immunomodulatory effects are distinguished, as well as different recent studies on possible preventives against SARS-CoV-2 by some plant drugs such as the bulb of Allium sativum L. (garlic), the bulb of Allium cepa L. (onion), the rhizome of Curcuma longa L. or the bark of Uncaria tomentosa (Will.) DC. Conclusions: Although some plants have demonstrated their action on the immune system, more research is still needed to learn more about the different properties and mechanisms involved in acting on the immune system.

Resumen Introducción: El sistema inmune puede verse afectado por distintos factores, por lo que en ocasiones el empleo de plantas medicinales es un remedio efectivo para estimular las defensas y prevenir resfriados. Con la llegada actual de la pandemia de COVID-19 se ha incrementado notablemente la demanda de estos medicamentos a base de plantas medicinales, por lo que se hace necesario su conocimiento por parte de los farmacéuticos comunitarios entre otros profesionales de la salud. Método: Se ha realizado una revisión bibliográfica sobre distintas plantas que actúan a nivel del sistema inmune en distintas bases de datos, revistas especializadas y libros. Resultados: Echinacea purpurea (L.) Moench, Panax ginseng C.A. Meyer, Eleutherococcus senticosus Rupr. y Maxim. y Pelargonium sidoides DC. han demostrado su actividad inmunoestimulante, indicadas para la prevención de afecciones respiratorias leves. Por otro lado, se distinguen distintas plantas poseedoras de vitaminas y minerales que pueden ejercer efectos inmunomoduladores, así como distintos estudios recientes intentan verificar posibles efectos preventivos frente al SARS-CoV-2 por parte de algunas drogas vegetales como el bulbo de Allium sativum L. (ajo), el bulbo de Allium cepa L. (cebolla), el rizoma de Curcuma longa L. o la corteza de Uncaria tomentosa (Will.) DC. Conclusiones: Aunque algunas plantas han demostrado su acción sobre el sistema inmune, aún son necesarias más investigaciones que permitan incrementar el conocimiento sobre las distintas propiedades y mecanismos implicados en la actuación sobre el sistema inmune.

Abstract The effect of oligofructose and/or curdlan oligosaccharides (CO) addition on the characteristics of probiotic fermented beverages processed with water-soluble rice extract (WSRE) was evaluated. The products were assessed for the physicochemical characteristics, rheological parameters, and probiotic survival (L. casei) during storage (28 days, 7 °C). Probiotic counts higher than 108 CFU mL-1 and 106 CFU mL-1 were observed during storage and after simulated gastrointestinal conditions (SGIC). Oligofructose addition increased the red color of the products (increase in a* values) and acted as a prebiotic component during storage and SGIC, increasing probiotic survival. CO addition resulted in higher acidity (lower pH and higher titratable acidity values) and lower consistency (lower k and higher n values). It acted as a prebiotic component during fermentation, storage, and SGIC, promoting the highest increase in probiotic survival. Furthermore, CO improved the storage stability, reducing the post-acidification and the alterations in the rheological parameters.

Abstract: The tropical fruits Musa paradisii L., “banana” (pseudobaya), Persea americana Mill., “Avocado” (berry), and Physalis peruviana L., “aguaymanto” (berry), are used in the industry for different purposes, such as food, cosmetic and medicinal, among others. The aim of the present work was to define the micrographic identification pattern of these three tropical fruits. The micrographic method was applied, the techniques of which were: a. mild decoupling with 5% NaOH solution at 100 ° C for 5 min and observation under the light microscope after washing; b. strong decoupling for woody material with 10% KOH at 100 °C and then with 25% chromic acid for 30 to 60 min.; c. scraping with a sharp cutting element, taking part of the material (powder or wet) and observation; d. histochemical reactions with Lugol to detect starch and Sudan III for lipids. The following indicators are proposed as elements of referential value for “bananas”: raphidia and simple, eccentric starch grains and as complementary elements fibers; for “avocado”: brachisclereids, crystals and lipid drops; for “aguaymanto”: microcrystals, simple and compound starch grains, lipid drops, astrosclereids of seeds and fibers and lipid drops of the fruit as complementary features. These elements allow to undertake botanical quality analysis of products derived from the fruits of the studied species, establishing their genuinity and the presence of contaminats or adulterants. It should be noted that applied microscopy is a scientific method, which turns out to be an adequate to control and certify food from vegetables.

Resumen: Los frutos tropicales Musa paradisii L., “banana” (pseudobaya), Persea americana Mill., “palta” (baya) y Physalis peruviana L., “aguaymanto” (baya), se utilizan en la industria para diferentes usos, alimenticios, cosméticos, medicinales entre otros. El objetivo del presente trabajo fue definir el patrón de identificación micrográfico de los tres frutos tropicales. Se aplicó el método micrográfico cuyas técnicas fueron: a. disociado leve: el material se trató con solución de NaOH al 5% a 100 °C durante 5 min y luego de lavado con agua destilada fue observado al microscopio óptico; b. disociado fuerte para material leñoso con KOH al 10% a 100 °C, lavado con agua destilada y luego tratado con ácido crómico al 25% por 30 a 60 min.; c. raspado consiste en obtener parte del material (polvo o húmedo) con un elemento punzocortante; d. reacciones histoquímicas con Lugol para detectar almidón y Sudán III para lípidos. Se proponen como elementos de valor referencial los siguientes indicadores: para “banana” rafidios y granos de almidón simples, excéntricos y como elementos complementarios fibras; en “palta” braquiesclereidas, cristales poliédricos y gotas lipídicas; en “aguaymanto” microcristales, granos de almidón simples y compuestos, astroesclereidas de semillas; fibras y gotas lipídicas del fruto son complementarias. Los elementos aportados permiten emprender análisis de calidad botánica de productos derivados de los frutos de las especies estudiadas, para establecer su autenticidad y la presencia de contaminantes o adulterantes. Cabe destacar que la microscopía aplicada es un método científico que resulta ser adecuado para controlar y certificar alimentos procedentes de vegetales.

Fridericia speciosa (Bignoniaceae) is a liana that occurs in humid to dry vegetation in eastern and southeastern Brazil. Species belonging to the genus Fridericia are employed as medicinal plants. This study evaluates the antipromastigote and cytotoxic activities of the crude extract, fractions, and compounds isolated from F. speciosa, and an HPLC (High-Performance Liquid Chromatography) analytical method was used to quantify the bioactive flavonoids. The flavonoids alpinetin (1), luteolin (2), diosmetin (3), and apigenin (4) were isolated from the active EtOAc-soluble fraction (EAF) of the crude ethanol extract (LCE) obtained from F. speciosa leaves. Both LCE and EAF were active against the normal human lung fibroblast cell line GM07492A (IC50 of 460.7 µg mL-1 and 381.4 µg mL-1, respectively). Only EAF showed activity against Leishmania amazonensis (80.4% at 50 µg mL-1). Compounds 1 and 2 were quantified by HPLC-DAD in both LCE (1: 6.21%; 2: 1.11%) and EAF (1: 45.32%; 2: 2.00%). At 100 µM, compounds1-4 inhibited L. amazonensis flagellar motility by 40.2%, 26.8%, 1.0%, and 24.8%, respectively, while their toxicities (IC50) to the normal cell were > 1000, 353.0, 766.2, and >1000 µg mL-1, respectively. Therefore, F. speciosa leaves are a prolific source of bioactive flavonoids.

Lipoxygenase (LOX) plays an important role in inflammatory processes and Arrabidaea brachypoda (DC.) Bureau (Bignoniaceae) has been described as presenting anti-inflammatory activity. Therefore, the objective of this study was to develop a high-performance liquid chromatography (HPLC) procedure to directly recognize LOX inhibitor compounds in A. brachypoda crude extract, facilitating the isolation, characterization of bioactive compounds, evaluation of natural compounds using an in vitro 15-LOX assay and prediction of the most probable binding modes of their main constituent through molecular docking simulations. The chemical analysis was performed by ethanol crude extract microfractionation using HPLC-DAD (diode array detector) associated to a fraction collector. The bioactive chromatogram displayed a peak with 50.9% LOX inhibition at 13.6 min retention time. The extract was purified and conandroside was isolated, presenting a LOX inhibitory activity with an inhibitory concentration (IC50) of 7.8 ± 1.1 µM, close to standard quercetin (IC50 7.6 ± 0.3 µM). Additionally, conandroside was not cytotoxic to normal cells (GM07492A). The LOX-conandroside complex displayed a slightly higher docking score (92.7) than quercetin (71.5). These results together suggest that conandroside could be explored as lipoxygenase inhibitor.

Abstract Two years ago, we held an exciting event entitled the São Paulo School of Advanced Sciences on Vaccines (SPSASV). Sixty-eight Ph.D. students, postdoctoral fellows and independent researchers from 37 different countries met at the Mendes Plaza Hotel located in the city of Santos, SP - Brazil to discuss the challenges and the new frontiers of vaccinology. The SPSASV provided a critical and comprehensive view of vaccine research from basics to the current state-of-the-art techniques performed worldwide. For 10 days, we discussed all the aspects of vaccine development in 36 lectures, 53 oral presentations and 2 poster sessions. At the end of the course, participants were further encouraged to present a model of a grant proposal related to vaccine development against individual pathogens. Among the targeted pathogens were viruses (Chikungunya, HIV, RSV, and Influenza), bacteria (Mycobacterium tuberculosis and Streptococcus pyogenes), parasites (Plasmodium falciparum or Plasmodium vivax), and the worm Strongyloides stercoralis. This report highlights some of the knowledge shared at the SPSASV.

For honey bees (Apis mellifera L.), the reward for pollination service is obtaining food: nectar, a sugar solution; or pollen, which contains a high percentage of proteins and lipids. There are also other floral rewards ecologically relevant for pollinators, like resins, and/or minor components, such as phytohormones and polyphenols. When rearing A. mellifera queens, several factors affect grafting success: age of the grafted larvae, design and position of the artificial queen cells, priming queen cells with royal jelly before grafting, or nutrition of the queen rearing colony. This study aimed to evaluate the effect of two phytohormones: gibberellic acid (GA) and indole acetic acid (IAA) on queen cell production, the development of hypopharyngeal glands of nurse bees, and the performance of queen bees in colonies of A. mellifera. The results indicate that GA positively infuences queens production efficiency in vertical orphaned colonies and their reproductive performances in honey bee colonies. These results support the potential of plant metabolites as dietary supplements to improve queen bee production methods and their performance in colonies as well.

Para la abeja melífera (Apis mellifera L.), la recompensa por la polinización es la obtención de alimento: néctar, una solución azucarada, o polen, que contiene un alto porcentaje de proteínas y lípidos. También hay otras recompensas florales ecológicamente relevantes, las resinas, y/o componentes minoritarios, como las fitohormonas y polifenoles. En la cría de reinas de A. mellifera diversos factores afectan el éxito de los traslarves: la edad de las larvas, el diseño y la posición de las celdas reales artificiales, el cebado de las cúpulas con jalea real o la alimentación de la colonia que criará las reinas. El objetivo de nuestro estudio fue evaluar el efecto de dos fitohormonas, ácido giberélico (GA) y ácido indoalacético (IAA) en colonias de A. mellifera sobre la producción de celdas reales, desarrollo de las glándulas hipofaríngeas de abejas nodrizas y desempeño de abejas reinas. Los resultados indican que el tratamiento con GA en colonias sometidas al método de semiorfandad para la cría de reinas, mejoró la eficiencia de la producción de las mismas y su rendimiento reproductivo en colonias de A. mellifera. Estos resultados apoyan el potencial de utilizar metabolitos vegetales como suplementos dietarios para mejorar los métodos de producción de abejas reinas y su desempeño en las colonias.

Abstract Cotton fiber characteristics are influenced by the genetic and environmental factors, such as management, climate maturation, and significantly by harvesting conditions. The objective of this study was to analyze the variables of cotton fiber characteristics depending on the, picker, and stripper harvest systems, in narrow row cotton system. The experiments are conducted for five seasons in Argentina. The two first season in watering crop a de the tree last at rainfall. The cotton samples, taken from the stored basket of harvesters, were derived by mechanical systems harvesting. The analysis of the frequency distribution of the most significant parameters that determine the quality of the cotton fiber allowed to detect minimum changes in the distributions and these did not modify the class interval more frequently, which would not imply changes in the technological quality of the fiber harvested with different systems of harvesting stripper in relation to the picker. The changes in the distribution were greater when the test was carried out in rainfed conditions due to a lower control of the fruiting of the crop, which makes the management of the crop relevant in systems that were harvested with stripper systems

Resumen Desde la introducción en la Argentina de los sistemas de producción de algodón en surcos estrechos la superficie de cosecha con plataformas recolectoras de tipo stripper ha aumentado y se han desarrollado variados sistemas. El objetivo del presente trabajo fue evaluar la calidad tecnológica de la fibra en algodones conducidos bajo sistema de surcos estrechos y recolectados bajos diferentes sistemas stripper y su comparación con el sistema picker. A partir del desmote de cada unidad experimental se individualizaron los fardos de fibras producidos y se analizaron por (HVI), obteniéndose valores de Longitud, Resistencia, Uniformidad, Micronaire, Elongación, y color a través de Rd y +b, con estos datos se construyeron tablas de frecuencias según los intervalos de clasificación para cada parámetro de calidad. El análisis de la distribución de frecuencias de los parámetros más significativos que determinan la calidad de la fibra de algodón permitieron detectar mínimos cambios en las distribuciones y estos no modificaron el intervalo de clase con mayor frecuencia, lo que no implicaría cambios en la calidad tecnológica de la fibra cosechada con distintos sistemas de cosecha stripper en relación con la cosecha picker. Los cambios en la distribución fueron mayores cuando el ensayo se realizó en condiciones de secano debido a un menor control de la fructificación del cultivo por lo que pone de relevancia el manejo de este en los sistemas que se cosecharan con sistemas stripper.

Abstract The ethanol crude extract from cashew (Anacardium occidentale L. Anacardiaceae) displayed significant antiplasmodial activity (IC50 0.577 µg/ml). Liquid chromatography-high resolution Mass spectrometry analysis was performed to identify the main compounds existing in the ethanol extract. The occurrence of anacardic acids, cardols, and 2-methylcardols derivatives was confirmed in the extract. The IC50 obtained, when the main isolated compounds were evaluated in Plasmodium falciparum D6 strain, ranged from 5.39 µM to >100 µM. Tested here for the first time, the data showed that cardol triene 1 (IC50 = 5.69 µM) and 2-methylcardol triene 4 (IC50 = 5.39 µM) demonstrated good antimalarial activity. In conclusion, Anacardium occidentale nuts presented relevant biological potential, and further studies should be considered.

This current study aims to analyze the contribution of futsal practice in global praxis and body image in children in a specialized motor stage, evaluating the motor performance before and after an intervention in the following factors: hands and feet global praxis and body image. It was adopted the application method of 18 one-hour twice a week session, divided into three modules, I) displacement activities in different directions; II) coordination activities and reaction time and III) throwing and kicking activities. Twenty male participants, aged 8 to 12 years, with normal motor development were used. The survey was conducted at a private school. The results found were a significant improvement in the hits of the tennis balls with hands and make the number of hits in kicking the ball with his feet. Regarding the analysis of body image after the proposed intervention, the children has shown the body parts performance incorporated in drawings that were not previously present. It is concluded that there are positive contributions of the futsal practice in respect to the global praxis practice and body image in children in a specialized motor stage.

Introdução: A cirurgia convencional de revascularização ultra-distal continua a ser pouco utilizada pela maioria dos cirurgiões vasculares. No entanto, os escassos estudos publicados mostram resultados muito favoráveis em termos de sobrevida e salvação de membro. Objetivos: Avaliar os resultados da cirurgia convencional de revascularização ultra-distal em doentes com isquemia crítica grau IV (estadios 5 e 6 da classificação de Rutherford); analisar os detalhes técnicos e de decisão cirúrgica que influenciam os resultados obtidos. Material e métodos: Estudo retrospetivo, envolvendo todos os doentes admitidos nesta instituição com isquemia crítica nos estadios 5 e 6 da classificação de Rutherford, submetidos a cirurgia convencional de revascularização ultra-distal. Foi considerado critério de inclusão a cirurgia de bypass às artérias plantares comum, interna ou externa e à artéria pediosa. Foi avaliada a mortalidade, taxa de preservação de membro, sobrevida livre de amputação major e permeabilidade da revascularização, por intermédio de curvas de Kaplan-Meier. Resultados: Entre Abril de 2012 e Março de 2016, 41 doentes (34 homens e 7 mulheres) com uma média de idades de 69.1 anos, foram submetidos a 50 procedimentos de revascularização ultra-distal, 35 dos quais à artéria pediosa, 10 a artérias plantares e 5 a procedimentos de resgate de failing graft. Em 84% das revascularizações (n=42) utilizou-se substituto venoso autólogo, sendo os restantes bypass compostos de PTFE e veia (n=8). O follow-up médio foi de 20.8 meses (2-47 meses). Não registámos qualquer mortalidade aos 30 dias e durante o follow-up a mortalidade global foi 7.3% (n=3). Ocorreram 9 oclusões das revascularizações (2 precoces e 7 tardias) e 5 amputações major. A permeabilidade primária foi de 78% e a permeabilidade primária assistida de 82%. A taxa de preservação de membro foi de 88.9% e, no final do follow-up, a sobrevida livre de amputação foi de 66%. Conclusões: Os resultados demonstram que, em centros especializados e com elevado volume, esta técnica é muito eficaz na salvação de membros em isquemia crítica nos estadios 5 e 6 da classificação de Rutherford. Estes procedimentos devem ser tomados em consideração na ausência de outros vasos pontáveis ou como resgate, em membros já submetidos a procedimentos de revascularização prévios.

Introduction: Ultra distal conventional revascularization is still underused by the majority of vascular surgeons. Nevertheless, the few studies published on this subject show very promising results in terms of limb salvage and amputation free survival. Objectives: The aim of this study is to evaluate the results of ultra distal conventional revascularization in patients with critical limb ischemia (stages 5 and 6 of Rutherford's classification). The technical details and surgical indications that influence results will also be analysed. Material and methods: Retrospective study analysing all patients admitted to this institution with the diagnosis of critical limb ischemia in stages 5 and 6 of Rutherford's classification, that were submitted to ultra distal conventional revascularization. Our inclusion criterion was bypass surgery targeting the common plantar, internal plantar, external plantar or dorsalis pedis. Mortality, limb salvage, amputation free survival and graft patency were analysed by means of Kaplan-Meier product-limit method. Results: Between April 2012 and March 2016, 50 ultra distal revascularization procedures, (35 targeting the dorsalis pedis artery, 10 to plantar arteries and 5 redo procedures for failing grafts) were performed in 41 patients (34 male and 7 female), with a mean age of 69.1 years. Autologous venous conduit was used in 84% of the procedures (n=42), with the remaining being composite bypasses of PTFE and vein (n=8). Mean follow-up was 20.8 months (2-47 months). There weren't any deaths within 30 days of surgery and mortality during follow up was 7.3% (n=3). There were 9 graft occlusions (2 early and 7 late) and 5 major amputations. Primary patency was 78% and primary assisted patency 82%. Limb salvage was accomplished in 88.9% of patients and amputation free survival was 66% at the end of follow-up. Conclusions: Our results show that, in high volume dedicated centres, these procedures are very effective for limb salvage in patients with critical limb ischemia in stages 5 and 6 of Rutherford's classification. They should be taken in consideration in the absence of more proximal patent arteries or in patients already submitted to former revascularizations.